Monday, April 6, 2009

Brown psychiatry chief Martin Keller to step down in June...

Martin Keller is finally stepping down as the long time chief of psychiatry at Brown University. Brown University officials made the announcement in a Dear Colleagues letter dated today from Edward J. Wing, Brown's new Dean of Medicine and Biological Sciences.

Keller is the latest psychiatry kingpin to fall. In recent months, Emory University forced its psychiatry chief Charles Nemeroff to step down and Stanford is looking for a new head to replace Alan Schatzberg after reports that these two prominent psychiatrists, like Keller, failed to disclose years of lucrative financial payments from the pharmaceutical industry.

While Brown officials insist that the decision to step down was Keller's, my understanding from several sources is that the university has been under pressure to take action against him for months.

As I have reported in Side Effects and my blog here and here, Keller not only failed to disclose the millions of dollars he has received over the years from companies whose drugs he was studying and promoting in medical journals and at conferences. But there is evidence that Keller and his co-authors misrepresented data in a clinical trial of Paxil to make the antidepressant look safer and more effective than it really was. This trial, known as study 329 and funded by GlaxoSmithKline, was published in 2001 and used by the drug company to heavily market Paxil for off-label use in children and adolescents.

Yet as it turns out, the data in this trial do not corroborate the company's claims that Paxil was more effective than a placebo or sugar pill in treating depression in adolescents. The 2001 study also under-estimated the rate of suicidal thoughts and behaviors among participants taking Paxil in the study (in a 2006 paper, GlaxoSmithKline acknowledged that those taking the drug were five times more likely to be suicidal than those taking the placebo). GlaxoSmithKline is now under investigation by federal Department of Justice officials, and Keller himself has been deposed by attorneys in Boston's U.S. attorney's office, according to sources.

I also understand that the NIH recently refused to renew a long-term research grant submitted by Keller, in large part because of the allegations about Keller's scientific misconduct and his failure to disclose his conflicts of interest. Although Brown officials refused to confirm the NIH action, if you search the federal database for NIH grants (CRISP), you can see that Keller currently has three long-term research grants with National Institute of Mental Health; one of those grants, for a study comparing psychotherapy to drugs in treating depression, runs out this June. Another grant, for a long-term collaborative study of depression, ends in January.

Until recently, Keller was a major rainmaker for Brown, bringing in millions in research funding from the NIH and pharmaceutical companies to the university's medical school. Indeed, in a 2006 deposition, Keller said his department of psychiatry received $50 million in research funding, a significant hunk of change. Some have speculated that is why Brown has been reluctant to move against him. But now that NIH is no longer renewing Keller's research grants, one might speculate that his usefulness to Brown has diminished.

All of this may explain why come June, Martin Keller will join Nemeroff and Schatzberg on the growing roster of once-powerful psychiatry chiefs who have toppled from grace.

Keller's position, much like that of Schatzberg and Bling-Bling, looked as safe a bet as the sun rising, tomorrow. One shouldn't forget that even the BBC's influence didn't ruffle Brown, when it ran its Panorama documentaries. It would be interesting to know what finally tipped the balance... Grassley? Endless blogging and media speculation, which reached critical mass and obliged the powers that be to acknowledge the very thing that had been known for years? Criticism from within the profession? A combination of these? Who knows?

One would like to think that Keller's case was just an isolated incident, but one just "knows" that there are plenty of would-be Kellers, waiting in the wings. I was just reading the link that Nancy provided, and I see that gifts to students are not unheard of... Laying the foundation for the next generation of KOLs, like the Russians recruiting at Cambridge? One shudders to think.

What bothers me is that it's taken so long for him to step down when he should have had consequences thrust down upon him sooner. Based on the information reported in Side Effects, there was enough to convict this poor, misguided fellow years ago.

Another concern I have is the likelihood that for every one of these fellows that fall victim to themselves, there's another one getting in somewhere creating perpetuity.

I do recognize, however, the vast improvements which have come about the last few years. It's some consolation but I still get a bit irritable when I think about all the misinformation that people still believe and I'm also frustrated that corruption still exists despite investigations that prove it exists, but yet people aren't facing consequences until they are backed in a corner with no escape and no one left to protect them.

I was having a discussion last week regarding youth and how they don't respect authority. I brought up the fact of how one need look no further than world news to see that the people in authority are often not to be respected, due to corruption, scandal, wagging dogs, cover-ups. No teenager who is informed about domestic or geopolitical would believe that there's a reason not to rebel or always question authority. It's difficult enough to raise teenagers, and one of the best ways is to lead by example. We have many good examples of role models or ethical politicians and businessmen and women in the world, but we have too many bad ones of whom we require less.

The link in my previous post is broken. Here is the new link for “Pharma policies deserve failing grade” by Sunil Hebbar, M.D., (’12) and Joelle Karlik, M.D. (’12). Members of Brown Pharmaceutical Policy Task Force. April 6. Published in The Brown Daily Herald, April 7, 2009:

About Me

Alison Bass is a Pulitzer Prize nominee and author of Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial, which won the NASW Science in Society Award. She was a longtime medical and science writer for The Boston Globe and has also written for The Miami Herald, Psychology Today and MIT's Technology Review, among other publications. A series she wrote for The Boston Globe on psychiatry was nominated for a Pulitzer Prize and she has received many other journalism awards. In 2007, she won a prestigious Alicia Patterson Fellowship to write Side Effects. Bass teaches journalism at Mount Holyoke College and Brandeis University.